SELF-AWARENESS

TABLE OF CONTENTS

Introduction�������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������3

Is this workbook right for you? (AUDIT questionnaire)������������������������������������������������������������������������������������������������������4

What does your score mean?���������������������������������������������������������������������������������������������������������������������������������������������5

Internal and External Supports��������������������������������������������������������������������������������������������������������������������������������������������������������6

Immediate crisis support����������������������������������������������������������������������������������������������������������������������������������������������������6

Your personal support system��������������������������������������������������������������������������������������������������������������������������������������������7

Self-Awareness�������������������������������������������������������������������������������������������������������������������������������������������������������������������������������8

Your current drinking patterns�������������������������������������������������������������������������������������������������������������������������������������������8

How do your numbers compare to the low-risk drinking guidelines? �������������������������������������������������������������������������������9

Setting goals������������������������������������������������������������������������������������������������������������������������������������������������������������������� 10

Life goals and alcohol use������������������������������������������������������������������������������������������������������������������������������������������������ 11

Cutting down or stopping drinking? ������������������������������������������������������������������������������������������������������������������������������� 12

Your change plan contract���������������������������������������������������������������������������������������������������������������������������������������������� 13

Keeping track of your drinking���������������������������������������������������������������������������������������������������������������������������������������� 14

Daily tracking log������������������������������������������������������������������������������������������������������������������������������������������������������������� 15

Triggers��������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 19

Strategies for Success������������������������������������������������������������������������������������������������������������������������������������������������������������������ 20

Handling tough situations����������������������������������������������������������������������������������������������������������������������������������������������� 21

Saying “no”��������������������������������������������������������������������������������������������������������������������������������������������������������������������� 21

Reward yourself�������������������������������������������������������������������������������������������������������������������������������������������������������������� 22

New activities ����������������������������������������������������������������������������������������������������������������������������������������������������������������� 23

Financial benefits of reducing or quitting drinking���������������������������������������������������������������������������������������������������������� 24

Dealing with Setbacks and Slips��������������������������������������������������������������������������������������������������������������������������������������������������� 25

Back on track plan����������������������������������������������������������������������������������������������������������������������������������������������������������� 26

Health Effects������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 27

Effects of high-risk drinking�������������������������������������������������������������������������������������������������������������������������������������������� 27

Alcohol use among smokers and cancer risk������������������������������������������������������������������������������������������������������������������� 28

Conclusion������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ 29

References������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ 30
INTRODUCTION

Welcome to the Self-Awareness Workbook! This workbook was developed by the Centre for Addiction and Mental
Health’s Nicotine Dependence Service. In this workbook, we offer guidance, tips, tools, and resources to help reduce or quit
drinking.

Why is this workbook important?

Alcohol is often enjoyed when socializing with friends or family. Different people drink alcohol at different levels. Everyone’s
body responds differently to the alcohol they consume. Regardless of how much you drink, it is important to know the
health effects linked to drinking alcohol, including cancers, liver damage, and high blood pressure. The harms of drinking
are especially high among people who smoke. Compared to people who do not drink or smoke, those who drink and smoke
heavily have a 300 times increased risk of cancer. Drinking alcohol makes it easier for cancer-causing chemicals in tobacco
smoke to be absorbed in the tissues of the mouth and can greatly increase the risk of developing cancers of the head, neck and
digestive system. This workbook is designed to help you understand your risks and address them in the best way for you.

This workbook is not for everyone!

As a first step, we recommend completing the questionnaire on page 4 and referring to page 5 to figure out if this workbook
is right for you.

If you have been found to drink at levels that indicate a high risk of alcohol dependence, this workbook is not appropriate for
you. We recommend you stop drinking alcohol and seek guidance from a health professional (see page 6).

If you have been found to drink at risky levels but not alcohol dependent, this workbook is for you! This workbook is
designed to help you create a healthy relationship with alcohol and reduce your risk of cancer associated with drinking alcohol
and smoking. You can directly decrease your risk by reducing or quitting drinking. By following the steps listed throughout
this workbook, we can help you set goals and make positive changes in your health and lifestyle.

There is no right or wrong way to use this workbook. Feel free to take your time with the activities and repeat them as often
as you would like. We hope this workbook can help you become self-aware of your drinking behaviour and improve your
quality of life.

Thank you for bringing us along on this journey. You can make the change, and we are here to help!

3
AUDIT questionnaire
This questionnaire is to help you figure out if this workbook is appropriate for you or not. For each question in the chart below,
CIRCLE the box that best describes your answer. Write the score for each circled box at the end of each line, then total these
numbers at the bottom of the page.

NOTE: In Canada, a single drink serving contains 13.6 grams of ethanol or “pure” alcohol. Although the drinks below are
different sizes, each one contains the same amount of pure alcohol and counts as a single drink:

341 mL (12 oz.) 341 mL (12 oz.) 142 mL (5 oz.) 43 mL (1.5 oz.)
of beer of cider/cooler of wine of hard liquor
(about 5% alcohol) (about 5% alcohol) (about 12% alcohol) (about 40% alcohol)

Questions 0 points 1 point 2 points 3 points 4 points #

pts.
1 How often do you have a drink containing Never Monthly or 2 to 4 times a 2 to 3 4 or more
alcohol? less month times a times a week
week
2 How many drinks containing alcohol do 1 or 2 3 or 4 5 to 6 7 to 9 10 or more
you have on a typical day when you are
drinking?
3 How often do you have 5 or more drinks on Never Less than Monthly Weekly Daily or
one occasion? monthly almost daily
4 How often during the last year have you Never Less than Monthly Weekly Daily or
found that you were not able to stop monthly almost daily
drinking once you had started?
5 How often during the last year have you Never Less than Monthly Weekly Daily or
failed to do what was normally expected of monthly almost daily
you because of drinking?
6 How often during the last year have you Never Less than Monthly Weekly Daily or
needed a first drink in the morning to monthly almost daily
get yourself going after a heavy drinking
session?
7 How often during the last year have you had Never Less than Monthly Weekly Daily or
a feeling of guilt or remorse after drinking? monthly almost daily
8 How often during the last year have you Never Less than Monthly Weekly Daily or
been unable to remember what happened monthly almost daily
the night before because of your drinking?
9 Have you or someone else been injured No Yes, but not in Yes, during
because of your drinking? the last year the last year
10 Has a relative, friend, doctor, or other health No Yes, but not in Yes, during
care worker been concerned about your the last year the last year
drinking or suggested you cut down?
Total points =

Note: This questionnaire (the AUDIT) is adapted from the National Institute on Alcohol Abuse and Alcoholism, which reprinted
the AUDIT with permission from the World Health Organization. To reflect drink serving sizes in Canada (13.6g of pure alcohol),
the number of drinks in question 3 was changed from 6 to 5. A free AUDIT manual with guidelines for use in primary care
settings is available online at www.who.org.

4
What does your score mean?
Now that you have competed the AUDIT questionnaire (page 4), total up your scores for each answer. The maximum possible
total is 40 points.

Compare your score with the chart below to help determine if this workbook is appropriate for you.

You are drinking at levels that indicate a high risk of alcohol dependence.
Women and This workbook may not be appropriate for you. We recommend you stop
Men: 20+ points drinking alcohol and seek guidance from a health professional (see page 5
for support options).

Women: 4-19 points You are drinking at levels that indicate risky drinking. We recommend you
Men: 5-19 points use this workbook to help you cut down or quit drinking alcohol.

You are drinking at low-risk levels. We encourage you to continue your

Women: 0-3 points progress to protect your health. You may choose to use this workbook to
Men: 0-4 points monitor your progress and increase your self-awareness.

Why is there a difference between women’s and men’s scores?

Research shows that women start to have alcohol-related problems at lower drinking levels than men
do. One reason is that, on average, women tend to weigh less than men. In addition, alcohol disperses
in body water, and pound for pound, women have less water in their bodies than men do. So after a
man and woman of the same weight drink the same amount of alcohol, the woman’s blood alcohol
concentration will tend to be higher, putting her at greater risk for harm.

Source: NIAAA. Rethinking Drinking: Alcohol & your health.

5
INTERNAL AND EXTERNAL SUPPORTS

Immediate crisis support

The following are a few resources to help you find support near you:

ConnexOntario provides free and confidential health services information for people experiencing problems with alcohol and
drugs, mental illness or gambling�

www.connexontario.ca
Drug and Alcohol Helpline provides information about drug and alcohol addiction services in Ontario� The service is live
answer 24/7, confidential and free.

Call 1-800-565-8603
Or visit their website: www.drugandalcoholhelpline.ca

Smokers’ Helpline is a free, confidential service offering support and information about quitting smoking and tobacco use.
There are 4 ways to get help from Smokers’ Helpline:

1. Call 1 877 513-5333

2. Join the online quit program for tips, tools and support 24/7

3. Sign up for customized text messages offering support

4. Access free booklets on smoking and quitting

Feeling depressed or anxious?

It’s common for people to feel depressed or anxious when working through risky health behaviours. Mild
symptoms may go away if you cut down or stop drinking. See your health care provider or a mental
health professional if your symptoms don’t go away or get worse. If you’re having suicidal thoughts,
call your health care provider or go to the nearest emergency room right away. Effective treatment is
available to help you through this difficult time.

Source: NIAAA. Rethinking Drinking: Alcohol & your health.

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Your personal support system
You can also seek help from the people in your life and support groups. Try to find trustworthy people in your life to share in
your journey, or find an established support group.

Who are some people that can help you in your journey to make a positive change?

Name:________________________________________________________________________________________

Phone: ___________________________ Email:_________________________________________

Name:________________________________________________________________________________________

Phone: ___________________________ Email:_________________________________________

Name:________________________________________________________________________________________

Phone:___________________________ Email:_________________________________________

Name:________________________________________________________________________________________

Phone:___________________________ Email:_________________________________________

Have a plan of how you want your support team to help you. Some options of what to ask for are:

“Please don’t offer me “Can we have an alcohol-

drinks.” free dinner party?”

“Do you have any “If you see that I’m

encouraging words to stressed, can you step
keep me going?” in and offer help?”

What are some other ways you could ask your support network for help?

_________________________________________________________________________________________________________

7
SELF-AWARENESS

This section focuses on some of the steps you can take to better understand your drinking patterns and to set goals for drinking
at healthier levels. You have already completed the AUDIT questionnaire on page 4.

Your current drinking patterns

This next exercise helps you understand your current drinking patterns by asking about your alcohol consumption over the past
7 days.

Reminder: In Canada, a single drink serving contains 13.6 grams of ethanol or “pure” alcohol. Although the drinks below are
different sizes, each one contains the same amount of pure alcohol and counts as a single drink:

341 mL (12 oz.) 341 mL (12 oz.) 142 mL (5 oz.) 43 mL (1.5 oz.)
of beer of cider/cooler of wine of hard liquor
(about 5% alcohol) (about 5% alcohol) (about 12% alcohol) (about 40% alcohol)

1. Please circle yesterday’s day of the week (e.g., if today is Monday, circle Sunday).
2. Starting on the day you circled (yesterday), please write down the number of drinks you had that day.
3. Continue following the arrows back. In each box, write the number of drinks you had on that day.
4. On days where you did not have anything to drink, please write “0.” Do not leave any of the boxes blank.

Monday

Sunday Tuesday

Saturday Wednesday

Friday Thursday

Add up the # of drinks over the past 7 days:

8
How do your numbers compare to the low-risk drinking guidelines?
What’s “low-risk” drinking?
Generally, the less alcohol you drink, the more you reduce your health risks. In Canada, there are a few low-risk
drinking guidelines established to help guide individuals to drink within safe limits. The Canadian Cancer Society (CCS)
makes recommendations to reduce the risk of developing cancer as a result of drinking alcohol:

Low-risk drinking limits Men Women

Less than Less than

On any
single
DAY 2 1
1 2 3
drinks on any day drink on any day
8 9 10
4 5 6 7 7
4 15 16 1
11 12 13 1
1 22 23 24
Less than Less than
18 19 20 2
25 26 27
28 29 30 3
1 Per
WEEK
14 7
drinks in any week
drinks in any week

You may see other low-risk drinking guidelines that allow for higher drinking levels on a given day or week. There is merit to
different recommendations, but the Canadian Cancer Society guidelines are set to reduce your risk of developing several types
of cancer, including mouth and throat cancers.

The risk of developing mouth and throat cancers is higher for smokers than for non-smokers

“Low risk” is not “no risk.” Even within these limits, drinkers can have problems if they drink too quickly, have health problems,
or are older. Based on your health and how alcohol affects you, you may need to drink less or not at all. If you are pregnant, you
are strongly advised not to drink at all.

What’s “risky” drinking?

For healthy adults in general, drinking more than the single-day or weekly limits recommended by the Canadian Cancer
Society is considered “risky” drinking.

About 1 in 4 smokers in Ontario drink at risky levels.

It makes a difference both how much you drink on any day and how often you have a “heavy drinking day”—that is, more than
5 drinks in a day. The more drinks in a day and the more heavy drinking days over time, the greater the chances for health
problems.

Source: NIAAA. Rethinking Drinking: Alcohol & Your Health; CAMH Internal Data.

9
Setting goals
Before setting specific goals, it is important to first decide whether you want to cut down drinking or quit drinking. Both are
legitimate goals. Your choice could depend on your personal circumstances.

It is recommended that you reduce drinking if you: It is recommended that you stop drinking if you:

• Were not recommended to quit drinking by your • Have been advised by your health care provider
health care provider to quit drinking
• Do not feel ready to quit drinking right now • Have health problems such as liver disease or
mental illness
• Drink at levels that don’t negatively interfere with
your: • Are taking medications such as sedatives,
painkillers or sleeping pills
ǿǿ Personal relationships
ǿǿ Work responsibilities • Have a personal or family history of drinking
ǿǿ Physical health problems
ǿǿ Emotional health
ǿǿ Social well-being • Have a family history of cancer or other risk
ǿǿ Spiritual/ethical well-being factors for cancer
• Are pregnant, trying to get pregnant or
breastfeeding (there is NO safe level of drinking
in this situation)
• Will be operating vehicles such as cars, trucks,
motorcycles, boats, snowmobiles, all-terrain
vehicles or bicycles
• Are responsible for the safety of others at work
or at home

Remember: If you scored 20 points or higher on the AUDIT questionnaire (page 4), we recommend you stop drinking alcohol
and seek guidance from a health professional (see page 6 for options).

Source: BC Partners for Mental Health and Addictions. Problem Substance Use Workbook; Capital Health Addiction Services.
My Choice: A workbook for making changes.

10
Life goals and alcohol use

Before thinking about your specific drinking goals, think more broadly about your life goals, at least for the next few months.
What do you hope to accomplish? Will your current level of drinking help or hurt your goals?

What would you want to accomplish over Would drinking at your current level make
the next few months? it EASIER or HARDER for you to reach
these goals?
Easier No effect Harder

1. _________________________________________________

2. _________________________________________________

3. _________________________________________________

4. _________________________________________________

5. _________________________________________________

Source: College of Family Physicians of Canada and Canadian Centre on Substance Abuse. Drinking Smart: Your Health and
Alcohol Consumption.

11
...

Cut down drinking Stop drinking

___________________________________________ ___________________________________________

___________________________________________ ___________________________________________

___________________________________________ ___________________________________________
Examples could include: to lose weight, to sleep better, to be a better parent to my kids, to be happier

Cons: What are some reasons why you might not want to...

Cut down drinking Stop drinking

___________________________________________ ___________________________________________

___________________________________________ ___________________________________________

___________________________________________ ___________________________________________

Take a look at your pros and cons� Highlight the points that you value the most�

Take a good look at your answers� What stands out as being very important to you? What is not as important as you thought it
might be?

Now it’s time to make a decision - which you can always change later! - about what will work best for you: cutting down or
stopping drinking?

Write your decision here: for my drinking goal, I have chosen to:

12
Your change plan contract

I want to drink no more than ___ drink(s) on any day and no more than ___ drink(s) per week
(see page 9 for low-risk drinking guidelines)

My goal: or

I want to stop drinking

My start date: I will start my change plan on this date: _____________________________________________

My reasons: My most important reasons to make these changes are:

_______________________________________________________________________________

_______________________________________________________________________________

My strategies: I will use these strategies to help make these changes (see page 20 for ideas):
_______________________________________________________________________________

_______________________________________________________________________________

My support system: The people who can help me are (names and how they can help) (see page 7 for ideas):
_______________________________________________________________________________

_______________________________________________________________________________

Signs that I will know my plan is working if:

I’m doing well:
_______________________________________________________________________________

_______________________________________________________________________________

My challenges Some things that might interfere and how I’ll handle them (see pages 19-21 for ideas):
and solutions:
_______________________________________________________________________________

_______________________________________________________________________________

Signature: _________________________________________________________________

Optional,

As your health care provider, I commit to providing professional support and guidance to help you make these changes:

Health Care Provider Signature: _______________________________________________

Source: NIAAA. Rethinking Drinking: Alcohol & Your Health. 13

Keeping track of your drinking
Keeping track of your drinking can give you an idea of how much you drink and in which situations. Tracking your smoking
alongside your drinking can help you get an overall picture of your behaviours and how they interact with each other.

You may find that keeping a drinking and smoking log helps you stick to your goals and monitor your progress. It may be
inconvenient to track every drink, but committing to a tracking log may prove useful over time.

You will be asked to track how many “standard” drinks you have each day. As a reminder, a “standard drink” in Canada is
measured as having 13.6 g of pure alcohol. The picture below may help give an idea of what that looks like in different types of
drinks:

Beer Cider/Cooler Wine Hard Liquor

341 mL 341 mL 142 mL 43 mL
(12 oz.) (12 oz.) (5 oz.) (1.5 oz.)
5% alcohol 5% alcohol 12% alcohol 40% alcohol

14
Daily tracking log
Instructions:
1. At the top of your daily tracking log, write your drinking goal if you have decided on one (see page 13). Leave this space
blank if you have not.

For each day:

Source: Capital Health Nova Scotia. My Choice! Daily Drinking Tracking Log.

15
Example: Daily tracking log
GOAL: No more than 3 drinks on a day and 15 per week.
Total # of Total # of Urges to Situation of the Thoughts and feelings about
cigarettes for standard drink? drinking or urge your drinking or urges
the day drinks for the
day
Feb / 2016 If you did not If you did not Rate the Write who you During the times you did drink
month/year smoke on a drink on a day, strength were with (or or had urges to drink, write
day write “0” write “0” of the urge alone) where you the feeling, thoughts you were
from 0-5 were, and when having at the time. (e.g., you
were bored, stressed, relaxed)
Monday 18 6 0 3 Fought really hard to resist a beer
after dinner

Tuesday 19 3 0 0

Wednesday 20 12 3 5 Was watching TV Was bored, nothing good on

TV

Thursday 21 9 0 4 Went to dad’s Wanted to drink but didn’t

house because dad is trying to quit

Friday 22 15 5 5 Went out to bar Wanted to relax after work, and

with friends party

Saturday 23 17 7 5 Had a get-together Was nervous that people were

at my place not having fun, and everyone else
was drinking

Sunday 24 8 0 2

Total # of drinks this week: __________15______________

Additional notes: I had some pretty strong urges this week. I don’t feel that I dealt with them in the best way since I drank over my
daily goal a bunch on the weekend. But I did have some urges which I dealt with. I didn’t drink on those days and I am happy about
that. I noticed I drink more when I’m smoking…I’m going to ask the nurse about that.

16
Daily tracking log
GOAL: No more than drinks on a day and per week.
Total # of Total # of Urges to Situation of the Thoughts and feelings about
cigarettes for standard drink? drinking or urge your drinking or urges
the day drinks for the
day
/ If you did not If you did not Rate the Write who you During the times you did drink
month/year smoke on a drink on a day, strength were with (or or had urges to drink, write
day write “0” write “0” of the urge alone) where you the feeling, thoughts you were
from 0-5 were, and when having at the time. (e.g., you
were bored, stressed, relaxed)
Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Total # of drinks this week: __________________________________

Additional notes: __________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

17
Daily tracking log
GOAL: No more than drinks on a day and per week.
Total # of Total # of Urges to Situation of the Thoughts and feelings about
cigarettes for standard drink? drinking or urge your drinking or urges
the day drinks for the
day
/ If you did not If you did not Rate the Write who you During the times you did drink
month/year smoke on a drink on a day, strength were with (or or had urges to drink, write
day write “0” write “0” of the urge alone) where you the feeling, thoughts you were
from 0-5 were, and when having at the time. (e.g., you
were bored, stressed, relaxed)
Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Total # of drinks this week: __________________________________

Additional notes: __________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

18
Triggers
Triggers are the patterns that usually occur before or around the time you drink. Triggers can be people, places, activities, etc.
For example, you might learn that you drink more when you are smoking, or when you visit your neighbour on the weekend. In
these cases, smoking and visiting your neighbour on the weekend are all triggers.

It is important to know what your triggers are and to have a plan for dealing with them in a way other than drinking. This will
give you a better chance of achieving your goals.

Identifying my Triggers
Note: To complete this exercise, you’ll need to have completed the Daily tracking log (page 17) for at least two weeks, preferably
longer. The longer you have completed the Daily tracking log, the more easily you’ll be able to see patterns in your drinking
behaviour.

Take a look at your entries in the Daily tracking log so far. Look at the days that you drank more than your daily goal and the
days you had the strongest urge to drink. Place a mark beside these days or highlight them. Now look at what you have written
in the last two columns on the days you highlighted (the ones titled “Situation of the drinking or urge” and “Thoughts and
feelings about your drinking or urges”). Copy what you wrote on those days here:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Source: Capital Health Addiction Services. My Choice: A workbook for making changes.

19
STRATEGIES FOR SUCCESS

Follow these tips to help you reduce the amount you drink or to quit drinking alcohol. By following these steps and coming up
with strategies of your own, you can improve your health and reduce your risk of developing certain cancers:

Steps to reduce drinking Steps to quit drinking

Plan ahead and set a limit on the amount you will drink (see If you are thirsty, use a non-alcoholic drink like water to
page 13). quench your thirst.

If you are thirsty, use a non-alcoholic drink like water to
quench your thirst.
Alternate alcoholic beverages with non-alcoholic drinks like
water, soft drinks or juice.
Drink alcoholic beverages slowly.
Do an activity when you are out with friends to help distract
you, like playing pool or dancing. Drink water during these
activities.
Don’t use alcohol to cope with stress. Go for a walk, take a
bath, read a book or listen to some of your favourite music to
help you relax.

Space out your alcoholic drinks. Have something to eat or a non-alcoholic drink.

Try to drink lower alcohol content drinks, or mix alcoholic
drinks with water, low-calorie soft drinks, club soda or juice.
Don’t refill your glass until it is empty.
Don’t “free pour” drinks because you may be drinking more
than you think. Measure the amount of alcohol when you
pour drinks so you know how much you are drinking.
Don’t try to keep up with your friends “drink for drink”
because everyone handles alcohol differently.
Leave the situation.
Use relaxation techniques, such as breathing or meditating.
Take the money you would have used to drink and put it
towards something you have always wanted (vacation, new
outfit, night out, etc.)
Make a list of why you don’t want to drink and refer to it
when triggers pop up.

Avoid playing drinking games because they can make you

drink large amounts of alcohol in a short time.

Eat before and while you are drinking.

Snack with your drinks, but avoid salty snacks like potato
chips. Salty snacks can make you thirsty and may cause you
to drink more and drink quickly.

Set small, reasonable goals for yourself. If you are a regular

drinker, try to set a goal of a few alcohol-free days each
week. Small goals like this will be more successful than trying
to cut out alcohol all at once.

Source: Canadian Cancer Society. Alcohol: Reducing your risk.

20
Handling tough situations
From time to time, you will find yourself in situations where you want to drink or where other people are drinking� You may
have learned about some of these situations when identifying your triggers on page 19.

You have many choices of how to respond to these situations, including the “Strategies for Success” examples provided on
page 20.

Which strategies do you think would work best for you?

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Saying “no”
When you are faced with an urge to drink or other people are drinking around you, having a plan of how to say “no” can be
extremely helpful� Some reasons for not drinking that you could use include:

“I am the designated driver today” “I promised my kids I wouldn't drink tonight” “No thanks, I'm trying to cut down”

What are some reasons you can provide for not having a drink when offered one?

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

21
Reward yourself
Committing to a healthier lifestyle deserves a reward! When you drink less, you spend less time on alcohol-related activities
(e�g�, sitting at a bar) and earn time to spend on other things you enjoy or have always wanted to do but never had the time�

For example, you can:

Spend more time with Volunteer at a local

your children shelter or hospital

Join a program at the

Start a new hobby
community centre

Planning ahead is important. When you are bored, you may be tempted to fill your time with familiar activities. In this
way, boredom can act as a trigger! When you plan ahead, you are giving yourself a chance to fill your time with a new or
different activity.

What would you do if you had MORE TIME?

________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

For inspiration, explore some options on the next page!

22
New activities
What are some activities you would like to try?
Poetry Keeping a diary Traveling Getting a pet

Running Learning magic tricks Clothesmaking Floral arranging

Tree planting Wood-carving Needlepoint Paint-by-numbers puzzle

Aromatherapy Ceramics Hiking Working in the garden

Doing crosswords puzzles Reading novels Birdwatching Meeting with friends

Writing short stories Swimming Getting a massage Meditating

Cooking Singing Fishing Photography

I will definitely try this! I might try this... No thank you!

Source: BC Partners for Mental Health and Addictions. Problem Substance Use Workbook.

23
Financial benefits of reducing or quitting drinking
Did you know the average Ontarian (15 years and older) spends $635.10 each year on alcoholic beverages?

How do you compare? You can use this guide to help you calculate how much you spend on alcoholic beverages in a year:

Alcohol
On average, how many days per week do you drink alcohol?
A Sample response: 4 days ____________________________________

On a typical drinking day, how many drinks do you have? ×

B Sample response: 2 drinks ____________________________________

What’s the average price you spend per drink? ×

C Sample response: $4 $___________________________________

Your spending average per week= A × B × C

Sample calculation: 4 × 2 × $4 = $32 $___________________________________

Your spending average per week × 52 weeks =

Your spending average per year $___________________________________
Sample calculation: $32 × 52 = $1664

By quitting drinking, you could save $ _________________________ per year! Think about all the possibilities.

What would you do if you had MORE MONEY?

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

To learn more, you can use the “Alcohol Spending Calculator” at the National Institutes of Health website:
http://rethinkingdrinking.niaaa.nih.gov/tools/Calculators/alcohol-spending-calculator.aspx

You can also calculate how much you spend on cigarettes with The Lung Association’s “Smoking cost calculator” at
https://www.quitnow.ca/tools-and-resources/calculate-your-savings

Source: Statistics Canada. (2014, March 31). Sales of alcoholic beverages per capita, 15 years and older.
24
DEALING WITH SETBACKS AND SLIPS

Sometimes it can be tough to stick to your goals. It is common to face challenges along a journey to make a positive change. It
is also normal to take more time to make a change than you expected.

Changing your drinking behaviour is a process that does not have a set timeline; it will take longer for some than others. If you
have a setback, you might be tempted to say, “Oh well, I failed to meet my goal so I guess I am back to square one.” Stop right
there.

A setback does NOT put you back at the beginning. Seeing a setback or slip as only a turn in the path or a bump in the road,
you are thinking positively and giving yourself the best chance of success.

There is a difference between a slip (setback) and a relapse.

A slip is considered any alcohol use above your drinking goal A relapse is returning to the same level and pattern of use
(i.e., one drink is a slip if your goal is to stop drinking. If your as before. For example, if you return to daily drinking, not
goal on a day is to drink less than two drinks and you had sleeping well, arguing with your partner, and missing work
four, you’ve had a slip.) when your goal was abstinence, you’ve relapsed.

When you know the difference between a slip and a relapse, you are more likely to bounce back from a slip. You will know how
to avoid turning that slip into a relapse and will feel more prepared to get back on track.

If you have a slip, don’t panic. Take some time to reflect on your journey so far by reading through this workbook and revisiting
your goals and motivations for changing (pages 11 and 13).

Remember: A slip does not mean you lost all the progress you have made. By completing this workbook, you already have a
better understanding of yourself and how to get back on track.

Source: Capital Health Nova Scotia. My Choice A Workbook For Making Changes.

25
Back on track plan
Slips can pop up at any moment and very quickly turn into something dangerous and uncontrollable. Preparing a “Back on
track plan” can help you feel ready to respond to a slip and prevent it from turning into a relapse.

What I will tell myself if I have a slip?

Example: “Don’t worry. I will do better next time.”

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

What steps will I take if I have a slip?

Example: “Take a hard look at my triggers and see what went wrong, then try to avoid my triggers next time they pop up.”

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

26
HEALTH EFFECTS

Effects of high-risk drinking

Aggressive, irrational behaviour. Arguments.Violence. Premature aging. Drinker’s nose.
Depression. Nervousness. Alcohol Dependence.
Memory Loss.

Cancer of throat and mouth.

Weakness of heart muscle. Heart failure.

Anemia. Impaired blood clotting. Breast
cancer.

Frequent colds.
Reduced resistance to infection.
Liver damage. Increased risk of pneumonia.

Ulcer

In men:
Impaired sexual performance. Vitamin deficiency. Bleeding.
For women: Severe inflammation
Reproductive health problems and of the stomach. Vomiting.
risk of giving birth to a child of Diarrhea. Malnutrition.
Fetal Alcohol Spectrum Disorder.

Trembling hands,
Impaired sensation leading to falls. trembling fingers.
Numbness. Painful nerves.

Numb, tingling toes, painful nerves.

Inflammation of the pancreas.

Adapted from Babor, T.F., et al. (2001). The alcohol use disorders identification test: Guidelines for use in primary care (p. 7).
2nd ed. Geneva: World Health Organization.

27
 Alcohol use among smokers and cancer risk

How does combined alcohol use What type of cancers does Low-Risk Drinking Guidelines for
and smoking cigarettes increase combined use cause? Reducing Cancer Risk
your risk of cancer?
Drinking alcohol and smoking cigarettes There is no evidence for a “safe” level of
Smoking and drinking alcohol usually go together greatly increases the risk of drinking that does not increase a person’s
hand in hand – people who drink are developing head and neck cancers. risk for cancer. Generally, the less alcohol
more likely to smoke than nondrinkers, These include: you drink, the lower your risk of cancer.
and vice versa.
The Canadian Cancer Society provides the
When alcohol enters your body, it breaks 1 2 following low-risk drinking guidelines for
down and releases toxic chemicals that
damage DNA and increase cancer risk. 4 3 adults who wish to lower their risk of cancer
from drinking alcohol.
Tobacco smoke contains 4000+
chemicals ; over 70 of these chemicals Less than 2 Less than 1
are carcinogenic (known to cause, 1. Oral cavity (mouth) drinks a day drink a day
initiate or promote cancer). 2. Pharynx (throat)
3. Larynx (voice box)
Drinking alcohol makes it easier for the 4. Esophagus (food pipe) Standard Drink Sizes (13.6g of alcohol)
cancer-causing chemicals in tobacco
smoke to be absorbed in the tissues of
the mouth.
Drinking above recommended
guidelines also increases the risk of
Drinking heavily and smoking developing cancer of the colon and Beer Cider/Cooler Wine Spirits
increases cancer risk by 300x* rectum by 1.5 times*
12 oz. 12 oz. 5 oz. 1.5 oz.
(5% (5% (12% (40%
alcohol alcohol alcohol alcohol
*Compared to people who don’t drink or smoke *If consuming about 3.5 alcoholic drinks a day content) content) content) content)

Benefits of quitting or reducing tobacco and alcohol use How can I reduce my cancer risk
Quitting Tobacco Drinking within from alcohol use?
recommended guidelines
When you are ready, here are a few steps to
get started:

Lower risk of: Lowers risk of: Lowers risk of:

• Cancer(s) • Head and neck • Cancer(s)
• Lung disease cancers • Liver disease
• Type 2 diabetes • Heart Disease • Motor vehicle accidents
• Vitamin deficiencies • Alcohol poisoning
• Asthma Improves: • Epilepsy Talk to a Fill out Quit/reduce
• Skin damage • Mental and physical • Stroke health care workbooks smoking
health professional to help manage
your drinking

28
CONCLUSION

Congratulations! You have reached the end of your journey with us. Thank you for taking the time to read through this
workbook and completing the suggested activities. Hopefully this workbook has been a useful tool in becoming more self-
aware about your relationship with alcohol and given you the strategies and support you need to be successful in reducing your
alcohol intake or quitting altogether.

This is a challenging journey to undertake so we understand if you may not have been successful the first time around. But
deciding to read through and complete this workbook is a success in itself! We hope you re-visit this resource to review, revise,
or reflect on your growth.

You may find it helpful to review your progress with your health care practitioner. If you feel you need more support along
the way, browse through your support options again on page 7.

We wish you all the best in your journey towards a more positive, healthy lifestyle !

This workbook is an adaptation of four evidence-based workbooks:

• BC Partners for Mental Health and Addictions. Problem Substance Use Workbook.

• Capital Health Nova Scotia. My Choice A Workbook For Making Changes.

• College of Family Physicians of Canada and Canadian Centre on Substance Abuse. Drinking Smart: Your Health and
Alcohol Consumption.

• NIAAA. Rethinking Drinking: Alcohol & Your Health.

Adaptations were shaped by a community-informed engagement event with clients enrolled in a smoking cessation
program at the Centre for Addiction and Mental Health (CAMH) and reported drinking alcohol above the Canadian Cancer
Society’s low-risk drinking guidelines.

The development of this workbook was funded by the Canadian Cancer Society (Grant #703404)

29
REFERENCES

Babor, T.F., et al. (2001). The alcohol use disorders identification test: Guidelines for use in primary care (p.7). 2nd ed. Geneva: World Health
Organization.

Bagnardi, V., Blaniardo, M., LaVecchia, C., and Carrao G. (2001) A meta-analysis of alcohol drinking and cancer risk. British Journal of Cancer,
85:1700–1705.

BC Partners for Mental Health and Addictions. Problem Substance Use Workbook. Retrieved from http://www.heretohelp.bc.ca/
publications/toolkits

Canadian Cancer Society. Alcohol. Retrieved from http://www.cancer.ca/en/prevention-and-screening/live-well/alcohol/?region=on

Canadian Cancer Society. Alcohol Rl;isk Factors. Retrieved from http://www.cancer.ca/en/cancer-information/cancer-101/what-is-a-risk-

factor/alcohol/?region=on

Cancer Care Ontario. Cancer Risk Factors in Ontario: Alcohol Report. Retrieved from https://www.cancercare.on.ca/ocs/csurv/info/
alcoholreport

Capital Health Nova Scotia. My Choice A Workbook For Making Changes. Retrieved from http://www.cdha.nshealth.ca/

Capital Health Nova Scotia. My Choice! Daily Drinking Tracking Log. Retrieved from: http://www.cdha.nshealth.ca/mental-health-and-
addictions/patients-clients-and-visitors/patient-resources

College of Family Physicians of Canada and Canadian Centre on Substance Abuse. Drinking Smart: Your Health and Alcohol Consumption.
Retrieved from http://www.sbir-diba.ca/resources/patient-resources

Health Canada. (2011, March 30).Tobacco Scientific Facts. Retrieved from www.hc-sc.gc.ca/hc-ps/tobac-tabac/fact-fait/facts-faits-eng.php

IARC. (2014). European Code Against Cancer - 12 Ways To Reduce Your Cancer Risk. Retrieved from http://cancer-code-europe.iarc.fr/index.
php/en/

NIAAA. Alcohol Spending Calculator. Retrieved from http://rethinkingdrinking.niaaa.nih.gov/tools/Calculators/alcohol-spending-calculator.

aspx

NIAAA. Assessing Alcohol Problems: A Guide for Clinicians and Researchers – Timeline Followback. Retrieved from: pubs.niaaa.gov

NIAAA. Helping Patients Who Drink Too Much. Retrieved from http://www.niaaa.nih.gov/guide

NIAAA. Rethinking Drinking: Alcohol & Your Health. Retrieved from www.RethinkingDrinking.niaaa.nih.gov

Pelucchi, C., Gallus, S., Garavello,W., Bosetti, C., & La Vecchia, C. (2006). Cancer risk associated with alcohol and tobacco use: Focus on upper
aero-digestive tract and liver. Alcohol Research & Health, 29(3), 193-198.

Statistics Canada. (2014, March 31). Sales of alcoholic beverages per capita, 15 years and older. Retrieved from: http://www.statcan.gc.ca/
daily-quotidien/150504/t150504a003-eng.htm#fn01

Szymańska, K., Hung, R. J.,Wünsch-Filho, V., Eluf-Neto, J.,Curado, M. P., Koifman, S., & Brennan, P. (2011). Alcohol and tobacco, and the
risk of cancers of the upper aerodigestive tract in Latin America: a case–control study. Cancer Causes & Control, 22(7), 1037-1046.

The Lung Association. Smoking Cost Calculator. Retrieved from https://www.quitnow.ca/tools-and-resources/calculate-your-savings

30